Commentary: Long-term COVID-19 complications are not rare and can be bad

By Arthur E. Sowers

The public needs to become more aware of the fact that there are often serious long-term complications in COVID-19 survivors and that these occurrences are not rare.

In review, what we know about COVID-19 at this time is that getting the disease has three possible basic outcomes. First, 80% of all cases have mild (about 45% of all) or no symptoms (about 35% of all) and full recovery. Second, cases with serious symptoms (up to about 20% of all cases) are followed by hospitalization and death. Death occurs in 1%-2% of all cases. However, death can be up to 10%-20% or more of cases in more vulnerable populations, such as seniors and those with underlying conditions. The third outcome involves serious long-term complications. This is now recognized to be about 5%-15% of all cases and is a different kind of bad outcome than death rates of 1%-2% of all cases.

Current statistics report, basically, three numbers: cases, hospitalizations and deaths. According to several sources, some COVID-19 patients have been in the hospital for three months and no one knows when their status will resolve. About one-third end up in intensive care unit beds. A high fraction of those do not end well, either.

There is not a statistic to describe average COVID-19 hospitalization periods compared to, for example, the hospitalization periods for the worst 10%. Thus, the seriousness is not quantified in a number for those 5%-15% of all cases. That seriousness is missed in the public consciousness. We all tend to think of illness in black or white terms: You are 100% well or 100% sick. Anything in between is short or transient and does not register on our minds. You may have people recovered well enough to be discharged from the hospital, but if they have long-term complications, they may still be unable to go back to work or enjoy normalcy in their lives and they may even be in that situation for the rest of their lives

A second factor that causes the public to miss the seriousness of these cases is the fact that the use of objective medical terms and descriptions has the effect of removing the subjective emotional experience from the clinical record. Tissue damage, multiple organ dysfunction and respiratory distress are just a few terms, and it is easy to say, “So what?”

The actual experiences of these patients with long-term complications – as revealed in recent extensive articles from interviews – tell a story of various kinds of perpetual misery, agony and depression, not to mention prospects of permanent unemployability. One report says up to one-third of these patients will likely develop PTSD

Another frustrating outcome from some COVID-19 cases is that a full recovery after mild symptoms will then be followed months later by a relapse into much worse symptoms, again with an unclear future.
Thus, the chances for COVID-19’s bad long-term complications might be about ten times more likely than death.

Arthur E. Sowers, Ph.D., is a retired research professor from the School of Medicine of the University of Maryland, Baltimore. His publications can be found at and He resides in Harbeson.